Personalisation: threat or opportunity?

A chance for practitioners to spend less time on care management and more time on good, old-fashioned social work. Threat or opportunity? A chance to do something about the woeful record of direct payments which after more than a decade still only account for £2 in every £100 spent on social care. Threat or opportunity?

These are questions that many social workers are asking themselves as the trickle of pioneering personalisation projects becomes a flood covering the whole of England. The principle is simple: give service users choice and control over the care and support they receive. As such it sits well with the government’s emphasis on citizenship and the drive towards consumerism in public services, but some social care workers remain to be convinced that all their service users are game for personalisation.

On this point the government is clear. In its new year letter to councils, Transforming Social Care, the Department of Health said that everyone receiving social care support, “regardless of their level of need”, would have choice and control over how that support was delivered. Within the next three years it expected to see “significant moves towards fundamental system-wide change”.

Individual budgets are at the heart of this change, similar in style to direct payments in that users are given a pot of money to spend on their own “self-directed support” but much more versatile. They can be a cash direct payment managed by the user, but they can also be managed by the local authority or a broker on the user’s behalf. If all goes to plan, various funding streams from different parts of government will be converted to individual budgets (see box).

The DH has been tight-lipped about the evaluation of the 13 individual budget pilot projects, handed to care services minister Ivan Lewis in April but not expected to be published until later in the summer. Initial indications suggest some resistance to individual budgets among older people and mental health teams, as well as difficulties pooling the several sources of funding in a single tranche of ready cash.

Health and social care consultant Melanie Henwood, who co-authored a major report on personalisation for the DH last year, agrees that take-up of direct payments has been unimpressive but blames it on the failure to promote them locally. “There was a tendency to assume that people wouldn’t want to be bothered with direct payments, but actually most people want to have control over their lives and individual budgets are about mediating this in a way that makes sense for them.”

Many care managers are likely to find that their jobs change significantly under personalisation as more emphasis is put on self-assessment by users, who then buy in their own services with support from a new breed of “brokers”. But Henwood argues that this is an opportunity rather than a threat for social work. “This is a real chance for social workers, not the beginning of the end. It marks a new phase going back to casework with families rather than being gatekeepers rationing resources.”

Not everybody is convinced. Ray Jones, a former social services director, is among the doubters. “I’m concerned that personalisation could be under-funded,” says Jones, who is now professor of social work at Kingston University. “The social care funding issue has been kicked into the long grass – we were promised a green paper this year now there’s a consultation about a consultation and the resulting legislation is likely to fall foul of the general election. And if it means raising taxes to pay for social care, which political party is going to do that?”

Jones is also concerned that disability-related social security benefits, received as of right by those who meet the criteria, could be transferred to the new system. “This would be to move from a rights-based system to a discretionary system of funding where the council decides whether it can afford to pay,” Jones says. “We need a rights-based national system for deciding on individual budget payments, leaving councils responsible for things like advocacy.”

What is certain is that personalisation will only work if eligibility thresholds for services are lower than they are now. Henwood says: “It would be very regrettable if gatekeeping remained paramount because eligibility criteria are so tight. We mustn’t raise people’s expectations and then say personalisation doesn’t apply because they don’t qualify.”

If the resources are in place, assessments and support plans will focus on quality of life rather than on tasks that users need to have done for them. Annual reviews of each service user on an individual budget, to monitor progress towards outcome targets, will ensure public money has been well spent, although headlines in the Daily Mail about alleged misuse of funds are inevitable.

“We will need to see beyond the shock-horror headlines to what this is achieving for people compared with the old system,” says Henwood. “It might mean tea dances and holidays abroad instead of respite care, or the leisure centre instead of the day centre. People taking individual budgets for the first time will need support and encouragement. They shouldn’t have control over buying from a standard menu, but control over buying from a menu of their own composition. That’s a big difference.”

Case Study

JULIA WINTER, individual budget holder

‘Social workers must now ask different questions’

Julia Winter has had a personal budget for her social care needs since they first became legal 11 years ago. “I became disabled in 1993 and first received a local authority service in 1996 – I had six different carers on different days, I didn’t know who was coming when, and I had a baby to look after,” she says.

But Winter, who uses a wheelchair, says direct payments transformed her life. “I employed my own personal assistants. I was able to decide who came through my door and when. I had two or three people coming in, rather than loads of people. I could identify priorities, what time they needed to be here, and what they should do when they got here.”

She transferred to an individual budget in 2006 as part of the pilot project in Essex, having herself become involved in promoting independent living as manager of Essex Coalition of Disabled People’s direct payments support service. Now a consultant for the Liberation Partnership, a user-led social enterprise, Winter says the main advantage of individual budgets is that social work assessments focus on quality of life rather than specific tasks with which help is required.

“The most important thing for me was to stay out of hospital. I’ve got a lung condition that makes it difficult to breathe in hot weather. So now my husband supports me at weekends and the money saved on paid support from my individual budget went on installing air conditioning at home. Consequently I haven’t had to go into hospital as much.

“Social workers ask fundamentally different questions. Rather than ask what help I need with things I can’t manage, my social worker asks what’s important to me. It has strengthened my partnership with my social worker, who says this is what she came into social work to do, help people have better lives.”

Pilot projects

Individual budgets were piloted in 13 local authorities from April 2006 to December 2007. The pilots were evaluated by the Personal Social Services Research Unit, the University of York’s social policy research unit, and King’s College London’s social care workforce research unit. The evaluation is expected to be published in the summer. The pilot authorities were:

Julia Winter has had a personal budget for her social care needs since they first became legal 11 years ago. “I became disabled in 1993 and first received a local authority service in 1996 – I had six different carers on different days, I didn’t know who was coming when, and I had a baby to look after,” she says.

But Winter, who uses a wheelchair, says direct payments transformed her life. “I employed my own personal assistants. I was able to decide who came through my door and when. I had two or three people coming in, rather than loads of people. I could identify priorities, what time they needed to be here, and what they should do when they got here.”

She transferred to an individual budget in 2006 as part of the pilot project in Essex, having herself become involved in promoting independent living as manager of Essex Coalition of Disabled People’s direct payments support service. Now a consultant for the Liberation Partnership, a user-led social enterprise, Winter says the main advantage of individual budgets is that social work assessments focus on quality of life rather than specific tasks with which help is required.

“The most important thing for me was to stay out of hospital. I’ve got a lung condition that makes it difficult to breathe in hot weather. So now my husband supports me at weekends and the money saved on paid support from my individual budget went on installing air conditioning at home. Consequently I haven’t had to go into hospital as much.

“Social workers ask fundamentally different questions. Rather than ask what help I need with things I can’t manage, my social worker asks what’s important to me. It has strengthened my partnership with my social worker, who says this is what she came into social work to do, help people have better lives.”

Individual budgets

Where the money comes from:

● Adult social services.

● NHS, if the government gives the go-ahead.

● Access to Work.

● Disabled Facilities Grant.

● Independent Living Fund.

● Integrated Community Equipment Fund.

● Supporting People.

● Possibly disability-related social security benefits, if the government gives the go-ahead.